Inverted Nipple/inflamation

[RW]

A friend of mine has had an inverted nipple that the Dr. has been watching for some time. At one time she actually had a little blood coming from her nipple as well.  Now she is experiencing a lot of redness, inflamation (inflammation) and pain of the breast. She has had an ultrasound and is waiting for the results. Should she insist on a biopsy or ultrasound?  Are these symptoms indicative of Breast Cancer?
Thanks! RW

[CCF-RN,MSN-JS]

Dear RW, As there has not been any determination of the cause of her symptoms, and they have been worsening further evaluation is warranted.  An option for her would be to seek the advise of a breast specialist.  

There is a type of breast cancer (inflammatory breast cancer) that presents with symptoms of redness, inflammation of the tissue of the breast.  These symptoms are similar to what would be seen with an infection.  So if symptoms are not getting better with treatment(antibiotics) of infection, further evaluation would be done.

[surgeon]

It could just be infection, but cancer is certainly something that needs to be ruled in or out. If she hasn't seen a surgeon who does breast surgery, she should, soon.

[mabelwabel]

First, I want you to know that there is a VERY great chance your rash is nothing.. HOWEVER..... I have Inflammatory Breast Cancer, a rare (about 4% of all cases) type of breast cancer that can be aggressive.

You MUST get this checked out immediately. My gynocologist blew me off, but my intuition sent me to another doctor immediately. There are many, many well meaning doctors who diagnose this as Mastitis or skin disorder.

Please, Please tell your doctor that you want to be tested for inflammatory breast cancer.

There is a web sight that is rather alarming but I would like for you to visit it. My symptoms were slightly red, swollen breast and my breast had peau de orange (these are pits in the breast). Like I said my doc said NO BIG DEAL. Turned out I had stage 3 cancer.

www.ibcsupport.org is alarming but does give info. The pictures of breast are of extreme cases, please note your breast does not have to look this bad to be IBC.

Please reply if you have more questions. Remember, this is MOST LIKELY NOTHING, but you can't afford to wait.

[mabelwabel]

Sorry again to alarm you but inverted nipple is NOT A GOOD THING and should not be "watched for some time" without a biopsy.  There are often no lumps with inflammatory breat cancer.

Please feel free to post back to me.  I am sorry If I am offending you but I wish to God I had heard of inflammatory BC before mine got to stage 3b.

[deky]

Not to alarm you, but once you get that biopsy, make sure your symptoms are going away.  My experience with two biopsies which showed negative for cancer, yet my symptoms did not diminish.  A third biopsy found cancer in the lymph node and by that time I was a stage IV with metastases.  Inflammatory breast cancer fools many physicians.

[farkle]

Sorry to butt in here, but I really need to ask both of you a couple of questions if I might. First, did either one of you experience severe itching/burning or stabbing pains? Or have an indentation form with veins bulging? Long story short, I've posted several times here myself in the past six months about problems w/ my left breast. The whole saga started back after Christmas with swelling, very pink skin, and intolerable itching. Several trips to breast clinic, U/S and mammo show nothing but small cysts. My regular doctor wants to put me on antidepressants because he thinks I'm obsessing. Funny, though, he changed his DX of my condition from "L nipple dermatitis" in April to "mastitis" this past week. He did refer me to a general surgeon to "ease my mind", but I haven't made an appointment yet. This is so frustrating- I'm afraid I'll sound just as nutty to the surgeon, and yet the level of discomfort I've been having tells me that SOMETHING must be wrong. I've been to the IBC Research site before, and many of the horror stories about late and/or missed diagnoses sound like the symptoms I've been experiencing. The one thing I do NOT have is the "peau d'orange"- and that seems to be the only thing anyone looks for!

[mamaligi]

This concerns the last person who wrote in about a several month history about a red breast which has progressed to a very bothersome, itchy breast.  If indeed you are telling the truth and every doctor you have seen in the past 9 months has essentially blown you off, you indeed are in trouble.

Your symptoms do sound like inflammatory breast cancer.  I have inflammatory breast cancer, so I can speak from personal experience.  I am also a physician.    

I suggest you contact the nearest medical school and their teaching hospital.  They will probaably have a Breast Center or Breast Clinic or Cancer Center.  Get in touch with the proper clinic and tell them that you are very concerned that you have inflammatory breast cancer and you would like to be seen by a physician as soon as possible.

If they are good guys they can get a fine needle aspiration biopsy done at that first appointment.  And, if needed, they can also get your mammogram squeezed in at that first visit as well.  If they think that something is very wrong, they will get those wheels turning.

The important thing is to get to the right people.  Most GP's haven't heard of inflammatory breast cancer and would not know what it is when looking right at it.  The same goes for internists.  A great number of surgeons are ignorant about this entity.

So, hit the telephone. If this will cost you money - pay it.  This is your life we are talking about.

Mamaligi

[mabelwabel]

I agree wholeheartedly with both these people.  I also have Inflammatory, i am 32 years old. and was real shocked when I first visited this sight yesterday and saw things like "inverted nipple" and "rash" with the answers not mentioning Inflammatory.

You go get a biopsy NOW.   I have orange peel look but only get the dimples when I squeeze my breast.   Please don't waste another minute.

[deky]

I am 61 years old and was flabbergasted when a physician suggested mastitis.  I agree with all of the above comments.  Get yourself to someone who can help you NOW--do not wait, inflammatory breast cancer keeps getting worse.  I know.

[farkle]

Thanks for your input, and I'm sure I would do well to take your advice- however, I do not believe the doctors at the breast clinic will listen to me, either. They reviewed all of my previous mammos & ultrasounds in late Feb.(including one done in early Feb. of this year that prompted my OB/Gyn to refer me TO the clinic) plus did their own, determined that the cysts looked normal & were too small to aspirate, and attributed all other symptoms to hormonal changes. The doctor I saw that day (VERY well-known and respected!) dismissed my question about IBC and told me that if I had it it would be obvious to her, and she sees hundreds of women every year with the same hormonal changes. I went home like a good girl, putting up with the "normal" stabbing, itching, burning pains, and sometime around late April noticed that this big vein was beginning to bulge in the left breast near the middle of my chest- the originating point being at or near where some stabbing pains occur. Not long after that, two more veins on the underside of the same breast did the same thing, only the pain/itch/burn is more intense there. Back to the clinic, second doctor did U/S and concurred with the first, suggested Mondor's as cause for veins with no other explanation. THEY are the local experts- what am I (the crazy person?) supposed to tell them to do?!?!

[LI Girl]

Yes!

[mamaligi]

Enough excuses.  Inflammatory breast cancer is infamous for not showing up on mammograms and ultrasounds.  So, if some doctors just reviewed those studies, without examining you, of course they might say nothing was wrong.  Now a few questions for our patient:  Is your breast always red and firm?  Is it always itching?  Is it larger than the other breast?  Is the rash permanent or does it come and go?

Now a suggestion that you may not like.  Since you seem so upset, please contact a psychiatrist.  Just about every IBC patient has sought the help of one or is taking some form of anti-depressant medication or anti-anxiety medication.  And several are in contact with counselors.  Coping with the  monster IBC is difficult.  I take those kind of medicaations and I am under the care of a psychiatrist.

I appeal to you to get proper medical care for your problem.  Writing to a forum like this will not help your disease.  The longer you wait, the lower you chances for survival if indeed you do have breast cancer.

I am sure that somewhere there is a knowledgable physician who, upon seeing your breast and hearing that it had not improved with antibiotic therapy, would be concerned about a diagnosis of cancer and would consider fine needle aspiration biopsies.

Mamaligi

[SnowWoman]

If your doctor gave you a referral to a surgeon, by all means make the appointment and go.  The only way to have some reassurance is to have a biopsy of the area -- insist on it with the surgeon.  Then you can either have some peace of mind or a confirmation if it is IBC.  From there you can move forward.

[farkle]

Quick answers to your questions: 1) no, it is not always red & firm- started out that way, but now only have firm areas in tissue where it itches and protruding veins are. 2) does not itch constantly, but before, during, and after stabbing pains- kind of burns before it itches. 3)yes, that breast is bigger than the other- always has been to some extent, but more noticeably now. 4) haven't really had rash for last few months, skin has slight pinkish tone- no doctor saw it when it was really swollen, red and itching, so i was never prescribed antibiotics! had small patches of rashy skin come & go since then, leaving small purple spots under skin where they were that the doctors attribute to stetch marks (i have always bee big busted, and nursed all three of my children) So, you see i do not have the hallmark skin symptoms of IBC, just these nagging weird coincidental things! And i do appreciate your counseling suggestion- i'm beginning to think i may just be obsessing after all!
To SnowWoman- thanks, I'm thinking it is probably the only way to find out for absolutely sure!

[highaim]

Hello to my sisters with IBC! I feel so alone at times....so it's nice to know you ladies are out there. I am 30 years old. Diagnosed May 2003. Stage IIIB.

IBC is also known (and I have heard this from more than one doctor) to "come and go". One day the breast is red and swollen....the next day it appears perfectly normal. And one doctor told me he has even seen cases when it appeared to respond to antibiotics- for a time. So just because it comes and goes does not mean it is NOT IBC. I am half way through treatment and my clinical symptoms still seem to come and go- which makes it difficult to know if it is responding to treatment. I had no lump- and nothing obvious showed up on mammo or ultrasound....other than a noted "thickening of skin" and inscreased density to both my breasts. The only way IBC can be diagnosed certainly is through biospy.

[farkle]

I had my annual appt. already scheduled with my OB/GYN for the 25th so I decided to wait until after she could examine me again before I decided what to do- after all, she was the first doctor to see me way back in February, and I trust her to give me her honest opinion about what I should do. She said she saw more changes in the shape and appearance in the left breast, and felt the new hard thick areas where a lot of my discomfort comes from, and she thinks one of my cysts has grown. She also felt a small hard lump that is in the fatty tissue near the bottom of my left armpit. I asked her if, in her opinion, the changes, symptoms, and differences between the two breasts is due to hormonal changes, and she told me that in her experience it is NOT. In my further discussion with her, I found out that the surgeon I have been referred to deals mostly with women's breasts, is supposed to be very good, and she would recommend that I call her (the surgeon) and follow through. I did so, and I have an appointment for Oct. 14th. So, hopefully I will get some answers in a few weeks! Thanks to all of you again for your advice & support- it was very much appreciated!

[prestressed]

A related discussion, red and inflammed was started.